| NPI | 1912937657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 52477) |
| Additional Taxonomies | 208800000X Urology (Licence: IA 34277) |
| 208800000X Urology (Licence: CA A90367) | |
| 208800000X Urology (Licence: PA MD-057761-L) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-04-18 |