| NPI | 1770771743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MS 20158) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 04-34962) |
| 208800000X Urology (Licence: MO 2011010495) | |
| 208800000X Urology (Licence: MS T-1890) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2019-07-11 |