| NPI | 1780840728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 86459) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102202552) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2022-03-27 |