| NPI | 1508361791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: MO 2026035471) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT231036) |
| 2088P0231X Urology, Pediatric Urology (Licence: KS 04-53219) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-07-24 |