| NPI | 1568640597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 217607) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60207158) |
| 208800000X Urology (Licence: GA 002054) | |
| 208800000X Urology (Licence: PA MD449258) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2021-04-01 |