| NPI | 1013208057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME132364) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101260296) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2018-01-29 |