| NPI | 1083697957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 7420231-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: NV 10095) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2018-10-22 |