| NPI | 1760575468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA G73785) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA G77558) |
| 2088P0231X Urology, Pediatric Urology (Licence: CA G73785) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-11-02 |