| NPI | 1164886644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IA MD-48735) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 68255-20) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-08-19 |