| NPI | 1124018999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IA 35033) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD489293C) |
| 208800000X Urology (Licence: MN 78018) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2025-06-06 |