| NPI | 1790715100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 67035) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 65927) |
| 208800000X Urology (Licence: WA MD60067817) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2023-09-25 |