| NPI | 1063640431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 5101018093) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 272974) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2022-07-21 |