| NPI | 1962897470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KS 04-44829) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2021026172) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-08-05 |