| NPI | 1154987600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 57.248345) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 14278986-1205) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2026-04-21 |