| NPI | 1972793396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME115276) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 49958) |
| 208800000X Urology (Licence: KY 42809) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2013-08-19 |