| NPI | 1912182189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 242839) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 242839) |
| 208800000X Urology (Licence: NJ 25MA08808100) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2025-09-23 |