| NPI | 1720074503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 1720074503) |
| Additional Taxonomies | 208800000X Urology (Licence: ME MD19054) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2021-02-02 |