| NPI | 1114999851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 062966) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101254296) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2023-07-21 |