| NPI | 1861755662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX S7087) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S7087) |
| 208600000X Surgery (Licence: SC LL34930) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2021-03-31 |