| NPI | 1083893101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME103855) |
| Additional Taxonomies | 208800000X Urology (Licence: WV 24854) |
| 208800000X Urology (Licence: MO 2011010512) | |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2023-08-18 |