| NPI | 1457748378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2022-00425) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ 60616) |
| 208800000X Urology (Licence: NC 209664) | |
| 208800000X Urology (Licence: NC 00425) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2023-01-20 |