| NPI | 1326046020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X (Licence: LA MD.016588) |
| Additional Taxonomies | 208800000X Urology (Licence: LA 016588) |
| 174400000X Specialist (Licence: VA 0101239234) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-04-21 |