| NPI | 1760687388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 8217924-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: FL TRN10997) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2012-06-27 |