| NPI | 1972525814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 85722) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101242805) |
| 208800000X Urology (Licence: NY 229887) | |
| 208800000X Urology (Licence: CO 48584) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2020-07-27 |