| NPI | 1679951180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 85517) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MT208316) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2023-06-14 |