| NPI | 1487179115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: KS 0447835) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2023014179) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2023-06-28 |