| NPI | 1518387224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A138666) |
| Additional Taxonomies | 208800000X Urology (Licence: CA 390200000) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2020-06-24 |