| NPI | 1831519024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12009400) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 280011) |
| 208800000X Urology (Licence: NH 20818) | |
| Enumeration Date | 2014-04-26 |
| Last Update Date | 2023-11-06 |