| NPI | 1124074786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301101647) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 236279) |
| 208800000X Urology (Licence: TX N3970) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-05-02 |