| NPI | 1922319359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 54630) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 105566) |
| 208600000X Surgery (Licence: MN 54630) | |
| 208600000X Surgery (Licence: NE 6316) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2020-08-21 |