| NPI | 1720157365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: TX Q5901) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101239362) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-02-19 |