| NPI | 1306078050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A114706) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2014-00467) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2021-11-03 |