| NPI | 1174584619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: FL ME138919) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 30855) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-04-19 |