| NPI | 1679066823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2019023349) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2018018333) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2019-07-25 |