| NPI | 1609215003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 5101020727) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2018011432) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2018-06-08 |