| NPI | 1568652964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX H1054) |
| Additional Taxonomies | 208800000X Urology (Licence: TX H1054) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |