| NPI | 1194920462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: LA 026088) |
| Additional Taxonomies | 2088P0231X Urology, Pediatric Urology (Licence: FL ME133119) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-07-16 |