| NPI | 1124096060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME103274) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 9901570) |
| 208800000X Urology (Licence: AZ 35491) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2016-03-17 |