| NPI | 1518915008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD043199L) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 17918) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-10-15 |