| NPI | 1629509385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: FL ME162026) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME162026) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2026-04-07 |