| NPI | 1114981065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MD D29143) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD D29143) |
| Enumeration Date | 2006-04-15 |
| Last Update Date | 2025-09-03 |