| NPI | 1992907034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA09400000) |
| Additional Taxonomies | 208800000X Urology (Licence: KY TP277) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-07-21 |