| NPI | 1619406766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: SC 87669) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.069905) |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2023-02-13 |