| NPI | 1023069986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PR 7613) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 39215) |
| 208800000X Urology (Licence: VA 0101048376) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |