| NPI | 1871663765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PR 05711) |
| Additional Taxonomies | 2088P0231X Urology Pediatric Urology (Licence: PR 5711) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-02-03 |