| NPI | 1689822413 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208800000X Urology (Licence: FL ME114730) | 
| Additional Taxonomies | 208800000X Urology (Licence: IL 125052815) | 
| Enumeration Date | 2008-09-04 | 
| Last Update Date | 2020-09-17 |