| NPI | 1235543984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: PA MT217642) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2014018109) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-05-19 |