| NPI | 1992900062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME113487) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA L-224804) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2016-10-13 |