| NPI | 1023422888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 102557) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 70500-21) |
| 208800000X Urology (Licence: MI 5101021091) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-01-23 |