| NPI | 1104920511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 50675) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 26795) |
| 208800000X Urology (Licence: AZ 33311) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2011-12-20 |