| NPI | 1538271861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 4991493-1205) |
| Additional Taxonomies | 284300000X Special Hospital (Licence: UT 4991493-1205) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-06-07 |