| NPI | 1215033618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD031203-E) |
| Additional Taxonomies | 208800000X Urology (Licence: TX G7505) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-10-20 |