| NPI | 1750737854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A176281) |
| Additional Taxonomies | 208800000X Urology (Licence: WA ML60767723) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2023-12-22 |