| NPI | 1467872291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-00390) |
| Additional Taxonomies | 2088P0231X Urology Pediatric Urology (Licence: NC 2021-00390) |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2021-08-09 |