| NPI | 1467680421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2015-02055) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301094879) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-08-23 |