| NPI | 1194772418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A49819) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 110101) |
| 208800000X Urology (Licence: GA 060213) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2012-06-15 |