| NPI | 1104858406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: LA MD206082) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ 37554) |
| 2088P0231X (Licence: DC MD039680) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-07-08 |