| NPI | 1053783860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: CA F404) |
| Additional Taxonomies | 208800000X Urology (Licence: CA F404) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |