| NPI | 1811106321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME111020) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301082481) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-07-19 |