| NPI | 1518903988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 79837) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 200301275) |
| 208800000X Urology (Licence: VA 0101257639) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-03-18 |