| NPI | 1588754592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: DC 9281DC) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC 9281DC) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-09 |