| NPI | 1952763245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MT210298) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD476849) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-07-12 |