| NPI | 1053573659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 51926) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 61525) |
| 208800000X Urology (Licence: KY TP713) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2021-01-29 |