| NPI | 1194948778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2012017449) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 04-35782) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2021-01-15 |