| NPI | 1912346024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX R6335) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2013020258) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-06-24 |