| NPI | 1831577873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: AR E-13178) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10052709) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2021-03-08 |