| NPI | 1790047280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2016-02380) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD465841) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-08-26 |