| NPI | 1548610967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-02014) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 5101022671) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2023-07-10 |