| NPI | 1477874568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 077660) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101250811) |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2017-03-22 |