| NPI | 1124218664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX U0488) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 61070) |
| 208800000X Urology (Licence: AR e-10949) | |
| 2088P0231X (Licence: MA 274247) | |
| 2088P0231X (Licence: ND 12523) | |
| 2088P0231X (Licence: OH 57.012388) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2023-11-28 |