| NPI | 1912141417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 98455) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 258802) |
| 208800000X Urology (Licence: VA 0101257619) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2024-04-29 |