| NPI | 1679856439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR 15049) |
| Additional Taxonomies | 208800000X Urology (Licence: OR 15049) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2020-07-23 |