| NPI | 1063875490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX U8100) |
| Additional Taxonomies | 208800000X Urology (Licence: CA 171780) |
| 208800000X Urology (Licence: OK 42945) | |
| 208800000X Urology (Licence: TN 70636) | |
| 208800000X Urology (Licence: CO DR.0072249) | |
| 208800000X Urology (Licence: MS 34075) | |
| 208800000X Urology (Licence: GA 92615) | |
| 208800000X Urology (Licence: AR E-17677) | |
| 208800000X Urology (Licence: LA 340289) | |
| 208800000X Urology (Licence: FL ME167214) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2026-07-30 |