| NPI | 1104808229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 36112) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101265824) |
| 208800000X Urology (Licence: CO CDR.0004667) | |
| 208800000X Urology (Licence: TN 40439) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2025-06-19 |