| NPI | 1063875490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX U8100) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 92615) |
| 208800000X Urology (Licence: CO DR.0072249) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2025-07-17 |