| NPI | 1467433599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301054798) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301054798) |
| 208D00000X General Practice (Licence: MN 63887) | |
| 208600000X Surgery (Licence: MI 4301054798) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2018-06-25 |