| NPI | 1700297728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA C170790) |
| Additional Taxonomies | 208800000X Urology (Licence: TX BP10049120) |
| 208800000X Urology (Licence: KY 49035) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2024-10-14 |