| NPI | 1497863096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD469641) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD 00039666) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-01-22 |