| NPI | 1104871367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 200200438) |
| Additional Taxonomies | 208800000X Urology (Licence: OR 33412) |
| 208800000X Urology (Licence: WA md00038538) | |
| 2088F0040X Urology, Urogynecology and Reconstructive Pelvic Surgery (Licence: NC 200200438) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-03-16 |