| NPI | 1194923474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-02891) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 53187-020) |
| 208800000X Urology (Licence: KY 46918) | |
| 208800000X Urology (Licence: VA 0101267273) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2023-07-28 |