| NPI | 1831241504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 88308) |
| Additional Taxonomies | 208800000X Urology (Licence: AL 30209) |
| 208800000X Urology (Licence: OK 24495) | |
| 208800000X Urology (Licence: MS 21735) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-07-12 |