| NPI | 1104185396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: NC 2022-02970) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2022-02970) |
| 208800000X Urology (Licence: NC 2022-02970) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2024-07-15 |