| NPI | 1104274174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: TX U4634) |
| Additional Taxonomies | 208800000X Urology (Licence: TX BP10057661) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-06-13 |