| NPI | 1811154362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA08723600) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD439845) |
| 208800000X Urology (Licence: NY 237376) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-03-04 |