| NPI | 1518047067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101236241) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101236241) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-02-06 |