| NPI | 1053524769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD448991) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 57.010506) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-07-18 |