| NPI | 1073552352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD12010) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60890461) |
| 208800000X Urology (Licence: NY 166815) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2021-06-17 |