| NPI | 1992156640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CT 74555) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61151828) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2023-07-27 |