| NPI | 1689025868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MN 69810) |
| Additional Taxonomies | 208800000X Urology (Licence: NE 7839) |
| 208800000X Urology (Licence: WI 75929-20) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-10-19 |