| NPI | 1659369981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301054162) |
| Additional Taxonomies | 208800000X Urology (Licence: MI KS054162) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2019-05-02 |