| NPI | 1225033442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 17808) |
| Additional Taxonomies | 208800000X Urology (Licence: MT 11769) |
| 208800000X Urology (Licence: AL 23959) | |
| 208800000X Urology (Licence: ND 11080) | |
| 208800000X Urology (Licence: ME 11769) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2010-09-10 |