| NPI | 1902882715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA OS004644L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA os004644l) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2011-01-28 |