| NPI | 1245236579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TN 0000055272) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 24957) |
| 208800000X Urology (Licence: IA 26305) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-01-01 |