| NPI | 1053579334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A117082) |
| Additional Taxonomies | 208800000X Urology (Licence: TX AO171708) |
| 208800000X Urology (Licence: NY 243288) | |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2021-12-15 |