| NPI | 1770676397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA05925200) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA05925200) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-05-01 |