| NPI | 1730329699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2009-00596) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD427102) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2012-06-06 |