| NPI | 1316612609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MDFE.FE.61130163) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 324560) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2023-09-18 |