| NPI | 1043386808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MA 230809) |
| Additional Taxonomies | 2088P0231X Urology, Pediatric Urology (Licence: MA 230809) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2012-04-19 |