| NPI | 1003161472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301101606) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301101606) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2017-02-08 |