| NPI | 1366608630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 201100924) |
| Additional Taxonomies | 208800000X Urology (Licence: TN 44906) |
| 208800000X Urology (Licence: IL 036116617) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2021-04-01 |