| NPI | 1710218185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD417701) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301405801) |
| 208800000X Urology (Licence: MN 38093) | |
| Enumeration Date | 2010-01-24 |
| Last Update Date | 2010-01-24 |