| NPI | 1578535977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SC 61218) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 61218) |
| 174400000X Specialist (Licence: PA MD070342L) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-06-02 |