| NPI | 1902425705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12774000) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 78367) |
| Enumeration Date | 2020-04-11 |
| Last Update Date | 2026-02-17 |