| NPI | 1104263771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60830922) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 298706) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2023-06-28 |