| NPI | 1861718736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX T1617) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 269743) |
| 208800000X Urology (Licence: MN 59047) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2023-06-28 |