| NPI | 1508831017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA C158684) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 9600268) |
| 208800000X Urology (Licence: TX L1189) | |
| 208800000X Urology (Licence: FL ME88129) | |
| Enumeration Date | 2006-02-19 |
| Last Update Date | 2019-10-04 |