| NPI | 1356316228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA C42239) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 04-26098) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-03-01 |