| NPI | 1578560413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA G14024) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G14024) |
| 2088P0231X Urology Pediatric Urology (Licence: CA G14024) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2023-03-07 |