| NPI | 1184601536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2011-00235) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 45839) |
| 208800000X Urology (Licence: MA 236691) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2012-05-08 |