| NPI | 1265400162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD025308E) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME117387) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-07-29 |