| NPI | 1558522987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO 0048806) |
| Additional Taxonomies | 208800000X Urology (Licence: IL 036144623) |
| 208D00000X General Practice (Licence: HI 15535) | |
| 208D00000X General Practice (Licence: CO 0048806) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2019-03-07 |