| NPI | 1396922670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: CA A82288) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A82288) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2012-10-30 |