| NPI | 1255376166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61294285) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ MA43259) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-06-10 |