| NPI | 1568818409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME158857) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101275089) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2023-10-29 |