| NPI | 1538455191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME1644485) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 288302) |
| 208800000X Urology (Licence: VA 0101264513) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-08-06 |