| NPI | 1396964904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WV 2246) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 390200000X) |
| 208800000X Urology (Licence: NC 2011-00041) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2015-12-15 |