| NPI | 1639531999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-01739) |
| Additional Taxonomies | 208800000X Urology (Licence: KY R4075) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-07-19 |