| NPI | 1609852987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA04135700) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101040080) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2026-05-18 |