| NPI | 1083619043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: UT 188550-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: NV 15297) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-06-16 |