| NPI | 1861606329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA08730700) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301079993) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-02-10 |