| NPI | 1104263540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A21089) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CA A21089) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2013-05-24 |