| NPI | 1972539963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: CA G70600) |
| Additional Taxonomies | 208800000X Urology (Licence: FL 83628) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-08-04 |