| NPI | 1154460780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OR 22332) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD22332) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-03-17 |