| NPI | 1073758652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A120604) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0116018913) |
| 208800000X Urology (Licence: DC 148669) | |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2017-08-09 |