| NPI | 1790104628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 201901591) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT205760) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2022-09-14 |