| NPI | 1053794016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A143235) |
| Additional Taxonomies | 208800000X Urology (Licence: CO DR.0063344) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2026-05-08 |