| NPI | 1700115698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA 20a4872) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA 20a4872) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |