| NPI | 1245492602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MO 203027604) |
| Additional Taxonomies | 208800000X Urology (Licence: PA OT012756) |
| 208800000X Urology (Licence: KS 05-36538) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-01-07 |