| NPI | 1639162340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 02686) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 200802054) |
| 208800000X Urology (Licence: VA 0102201274) | |
| Enumeration Date | 2005-08-27 |
| Last Update Date | 2022-01-20 |