| NPI | 1417956723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD062126L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD062126L) |
| 208800000X Urology (Licence: WV 28328) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2023-05-04 |