| NPI | 1912327594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA11215800) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 284566) |
| 208800000X Urology (Licence: OH 123193) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2022-01-02 |