| NPI | 1336213883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SC 21281) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 99-00476) |
| 208800000X Urology (Licence: VA 0101045853) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2021-05-26 |