| NPI | 1578524955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX M7608) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD-055513-L) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2010-03-30 |