| NPI | 1578677803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 6992956-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: TN MD25244) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-06-10 |