| NPI | 1376692194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 59763) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 61947) |
| 208800000X Urology (Licence: FL ME127813) | |
| 208800000X Urology (Licence: NE 31272) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-03-25 |