| NPI | 1699092056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: SC 86892) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME132919) |
| 208800000X Urology (Licence: LA 301759) | |
| 208800000X Urology (Licence: GA 86376) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2021-11-22 |