| NPI | 1447255963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CT 046626) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI MD08941) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2014-12-03 |