| NPI | 1376967901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NE 33461) |
| Additional Taxonomies | 208800000X Urology (Licence: IA 48581) |
| 208800000X Urology (Licence: UT 10132508-1205) | |
| 208800000X Urology (Licence: MN 66324) | |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2021-09-01 |