| NPI | 1124077508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 110638) |
| Additional Taxonomies | 208800000X Urology (Licence: TN 50936) |
| 208800000X Urology (Licence: NE 23123) | |
| 208800000X Urology (Licence: KY 46605) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2026-05-29 |