| NPI | 1689661126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME68265) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61002944) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2021-04-29 |