| NPI | 1134352115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD470357) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101264216) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2020-08-17 |