| NPI | 1376651265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA G88841) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 0418998) |
| 208800000X Urology (Licence: MO R3C49) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-08-19 |