| NPI | 1174713218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CT 051947) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 233892) |
| 208800000X Urology (Licence: TX N9719) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2014-03-12 |