| NPI | 1902255888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MB10982600) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 34.015010) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-08-28 |