| NPI | 1972571990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA05585800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA05585800) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-08-17 |