| NPI | 1306943576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SD 9532) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME117176) |
| 208800000X Urology (Licence: ND 11033) | |
| 208800000X Urology (Licence: MN 48726) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-09-15 |