| NPI | 1588045819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-00288) |
| Additional Taxonomies | 208800000X Urology (Licence: TX S3439) |
| 208800000X Urology (Licence: NJ 208800000X) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-07-01 |