| NPI | 1063687051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 13899185-1204) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ 006115) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2024-08-14 |