| NPI | 1821448309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: ZZ 41122) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ 140779) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |