| NPI | 1831410588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD456743) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197406) |
| 208600000X Surgery (Licence: NJ 25MA10327800) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2020-04-28 |