| NPI | 1700299773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.0071211) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0102204301) |
| 208D00000X General Practice (Licence: VA 0102204301) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2023-06-13 |