| NPI | 1124315585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: OH 35.127988) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ R72562) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2023-10-07 |