| NPI | 1780794206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: FL ME143435) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 056280) |
| 208800000X Urology (Licence: GA 056280) | |
| 2088P0231X (Licence: GA 56280) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-08-03 |