| NPI | 1811517139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA13078300) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 1022225) |
| 208800000X Urology (Licence: PA MD493900) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2026-08-14 |