| NPI | 1114147097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WV 4716) |
| Additional Taxonomies | 208800000X Urology (Licence: TX W0475) |
| 208800000X Urology (Licence: MI 5101017058) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-10-08 |