| NPI | 1376749861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 072548) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 072548) |
| 208600000X Surgery (Licence: MA BB5204071-MA00) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-11-01 |