| NPI | 1245210640 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: AZ 34124) | 
| Additional Taxonomies | 208800000X Urology (Licence: AZ 34124) | 
| Enumeration Date | 2006-01-20 | 
| Last Update Date | 2018-02-06 |