| NPI | 1447630637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA OS021040) |
| Additional Taxonomies | 208800000X Urology (Licence: CT 064946) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-04-28 |