| NPI | 1982664900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2012-02376) |
| Additional Taxonomies | 208800000X Urology (Licence: TX H4841) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2021-08-19 |