| NPI | 1952393217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA OS-005929-L) |
| Additional Taxonomies | 208800000X Urology (Licence: PA 05-005929-L) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2019-04-16 |