| NPI | 1083690259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA G128434) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101052018) |
| 2088P0231X Urology, Pediatric Urology (Licence: ND PT 12603) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2016-10-21 |