| NPI | 1023211547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD208021) |
| Additional Taxonomies | 208800000X Urology (Licence: TX P3486) |
| 208800000X Urology (Licence: FL TRN10996) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2022-01-24 |