| NPI | 1699718809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 6602968-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 46318) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-03-06 |