| NPI | 1619236973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MD D0087439) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10043029) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2022-01-09 |