| NPI | 1194927376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 55657) |
| Additional Taxonomies | 208800000X Urology (Licence: NM MD2015-0773) |
| 208800000X Urology (Licence: ID M-11543) | |
| 282N00000X General Acute Care Hospital (Licence: PR 11563-I) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2025-11-02 |