| NPI | 1619402286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: ID M-16761) |
| Additional Taxonomies | 208800000X Urology (Licence: MT 114025) |
| 208800000X Urology (Licence: UT 10959125-1205) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2022-10-21 |