| NPI | 1841255585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WY 12472A) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 5101011241) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2023-10-19 |