| NPI | 1386943801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 54536) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301113453) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2021-05-27 |