| NPI | 1063866796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 79356) |
| Additional Taxonomies | 208800000X Urology (Licence: MT MED-PHYS-LIC-103596) |
| 208800000X Urology (Licence: CO DR.0066966) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2025-04-07 |