| NPI | 1649663493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 69891) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301504806) |
| 208800000X Urology (Licence: WI 81570) | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2023-07-06 |