| NPI | 1700225380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME146285) |
| Additional Taxonomies | 208800000X Urology (Licence: FL 19114) |
| 208800000X Urology (Licence: NC 2018-00793) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2021-08-03 |