| NPI | 1659691053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD475728) |
| Additional Taxonomies | 208800000X Urology (Licence: KY 46363) |
| 208800000X Urology (Licence: KY FL035) | |
| 2088P0231X (Licence: KY FL035) | |
| 2088P0231X (Licence: KY 46363) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2021-12-08 |