| NPI | 1871693838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WY 3547A) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 166834-1205) |
| 208800000X Urology (Licence: CA G42452) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-11-19 |