| NPI | 1366753709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 9683273-1204) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 34.011766) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2023-11-13 |