| NPI | 1780685438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TN 0000004878) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 4878) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2015-06-11 |