| NPI | 1376542688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD025873E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD025873E) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2014-08-07 |