| NPI | 1427175512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO 14087INACTIVE) |
| Additional Taxonomies | 208800000X Urology (Licence: NE 9996ACTIVE) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2023-03-07 |