| NPI | 1497144562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD457337) |
| Additional Taxonomies | 208800000X Urology (Licence: WA FE60520498) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2018-11-03 |