| NPI | 1194105379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 61141) |
| Additional Taxonomies | 208800000X Urology (Licence: TX S6896) |
| 208800000X Urology (Licence: VA 0101275139) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-08-26 |