| NPI | 1669886537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME154933) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105492) |
| 208800000X Urology (Licence: MO 2019024767) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-03-28 |