| NPI | 1164457198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: LA MD07209R) |
| Additional Taxonomies | 208800000X Urology (Licence: WV 16322) |
| 208800000X Urology (Licence: KY 28473) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-07-15 |