| NPI | 1114556149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 113706) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4351048154) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-06-22 |