| NPI | 1003895954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: NC 9600282) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9600282) |
| 2088P0231X Urology Pediatric Urology (Licence: SC 18483) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-10-13 |