| NPI | 1639274087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 134016) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 47566) |
| 208800000X Urology (Licence: MS 20355) | |
| 208800000X Urology (Licence: AZ 36460) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-03-02 |