| NPI | 1154682565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: ID O-1041) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 5315055574) |
| 208800000X Urology (Licence: MI 5101019997) | |
| 208800000X Urology (Licence: MI O-1041) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2022-07-21 |