| NPI | 1720085624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME121324) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 055079) |
| 208800000X Urology (Licence: WI 66348) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-12-16 |