| NPI | 1043248537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 29800) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME102983) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-12-02 |