| NPI | 1760434054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME 50896) |
| Additional Taxonomies | 208800000X Urology (Licence: TX F8323) |
| 208800000X Urology (Licence: MO 2010007604) | |
| 208800000X Urology (Licence: MA 242506) | |
| 208800000X Urology (Licence: MS 21361) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-01-10 |