| NPI | 1710299706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: MO 2017002201) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 54064) |
| 2088P0231X (Licence: KS 04-39904) | |
| 2088P0231X (Licence: CO DR.0055046) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2022-07-21 |