| NPI | 1164528667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2010003415) |
| Additional Taxonomies | 208800000X Urology (Licence: NH 11333) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-10-27 |