| NPI | 1144631151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX S0517) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10050999) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2019-05-09 |