| NPI | 1033180062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 43758) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01049774) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2013-10-30 |