| NPI | 1154533297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 51612) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 110592) |
| 208800000X Urology (Licence: WA MD60750057) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2026-01-29 |