| NPI | 1851854624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12711600) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD491909) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-11-14 |