| NPI | 1053725077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX T2080) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206044) |
| 208800000X Urology (Licence: MI 4301512682) | |
| 2865M2000X Military Hospital, Military General Acute Care Hospital (Licence: IN 01075743a) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2025-07-14 |