| NPI | 1518006931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: SD 1249) |
| Additional Taxonomies | 208800000X Urology (Licence: NE 14907) |
| 208800000X Urology (Licence: IA 20455) | |
| 208800000X Urology (Licence: AZ 24696) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |