| NPI | 1497968143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PR 13100) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 13100) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2013-02-05 |