| NPI | 1114284874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2017013154) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 0439989) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2021-01-15 |