| NPI | 1679210637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A183503) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ZZ 111962) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2023-01-10 |