| NPI | 1730107343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA G78361) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G78361) |
| 2088P0231X (Licence: CA G78361) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-01-09 |