| NPI | 1700895000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: WA MD60238195) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60238195) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-11-01 |