| NPI | 1104811876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MA 154763) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME150186) |
| 208800000X Urology (Licence: OH 35076101) | |
| 208800000X Urology (Licence: AR E-10021) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2024-01-26 |