| NPI | 1558356121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME0046763) |
| Additional Taxonomies | 208800000X Urology (Licence: CA GFE66696) |
| 208800000X Urology (Licence: VA 0101056778) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2023-03-07 |