| NPI | 1356637698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A142398) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2011018417) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2022-06-14 |