| NPI | 1780627661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA04973500) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ MA49735) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-03-07 |