| NPI | 1023049129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: ND 4022) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 29669) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-12-16 |