| NPI | 1629202957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.133349) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 71566) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2018-07-06 |