| NPI | 1700854395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301089312) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 47160020) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2010-11-02 |