| NPI | 1407848195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME101466) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301513068) |
| 208800000X Urology (Licence: WI 84819) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2025-01-03 |