| NPI | 1063619237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ND 12119) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 49436) |
| 208800000X Urology (Licence: MS 21482) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-09-24 |