| NPI | 1104802859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 9900025) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9900025) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2021-05-26 |