| NPI | 1033630173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2024031946) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7945) |
| 208800000X Urology (Licence: CA A176098) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-05-14 |