| NPI | 1851596035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA OS014150) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT011622) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-05-25 |