| NPI | 1457352684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2013-01822) |
| Additional Taxonomies | 208800000X Urology (Licence: AL 22601) |
| 208800000X Urology (Licence: WI 37437-020) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2025-02-11 |