| NPI | 1609133081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME120400) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2017-00795) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2022-03-17 |