| NPI | 1669496717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD051871L) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ MA055546) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-02-11 |