| NPI | 1649354044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: FL ME120545) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD065637L) |
| 208800000X Urology (Licence: FL ME120545) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-11-12 |