| NPI | 1497729727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: VA 0101273176) |
| Additional Taxonomies | 2088P0231X Urology Pediatric Urology (Licence: FL ME59937) |
| 2088P0231X Urology Pediatric Urology (Licence: KY TP103) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-09-12 |