| NPI | 1568803013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: CA A126481) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A126481) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2013-07-12 |