| NPI | 1679770051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME114334) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101251366) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-09-22 |