| NPI | 1083823785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX Q0209) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD453417) |
| 208800000X Urology (Licence: MT MED-PHYS-LIC-34911) | |
| 208800000X Urology (Licence: FL ME115344) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-04-22 |