| NPI | 1407972748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO 0061310) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.124196) |
| 208800000X Urology (Licence: MN 104902) | |
| 208800000X Urology (Licence: MN 53371) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2019-01-24 |