| NPI | 1639169774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: NV NV10623) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV 10623) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2018-03-17 |