| NPI | 1689614695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MT 10719) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A56050) |
| 208800000X Urology (Licence: WY 7153A) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-12-13 |