| NPI | 1699790980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA06565100) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA65651) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-03-10 |