| NPI | 1073675591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A96534) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME120703) |
| 208D00000X General Practice (Licence: CA A96534) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2018-03-14 |