| NPI | 1063640555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: ME DO2978) |
| Additional Taxonomies | 208800000X Urology (Licence: TX Q1012) |
| 208800000X Urology (Licence: CA 14109) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-02-03 |