| NPI | 1164428140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101248303) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 96-00428) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2012-07-10 |