| NPI | 1972896777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX R6950) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A142267) |
| 208800000X Urology (Licence: KS 94-07638) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2018-06-26 |