| NPI | 1043585557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MA 252332) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301097311) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2013-07-15 |