| NPI | 1588001044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2020-03138) |
| Additional Taxonomies | 208800000X Urology (Licence: SC 91229) |
| 208800000X Urology (Licence: WI 70005) | |
| 208800000X Urology (Licence: MN 63963) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2024-01-05 |