| NPI | 1104896786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: OR 17952) |
| Additional Taxonomies | 208800000X Urology (Licence: OR 25042) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2011-10-05 |