| NPI | 1164606042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101250886) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 002739) |
| 208800000X Urology (Licence: GA 002739) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2014-03-19 |