| NPI | 1992153381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A166412) |
| Additional Taxonomies | 208800000X Urology (Licence: RI LP03706) |
| 208600000X Surgery (Licence: RI LP03706) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-02-21 |