| NPI | 1063824688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MS 26534) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME124782) |
| 208800000X Urology (Licence: FL 19690) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-07-08 |