| NPI | 1881692903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NE 17274) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 17274) |
| 174400000X Specialist (Licence: IA 30336) | |
| 208800000X Urology (Licence: IA 30336) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-02-25 |