| NPI | 1164631149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: LA 312724) |
| Additional Taxonomies | 208800000X Urology (Licence: TN 47657) |
| 208800000X Urology (Licence: SC TL31990) | |
| 208800000X Urology (Licence: LA 201000) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2019-06-19 |