| NPI | 1871698597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301088941) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD434561) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-11-04 |