| NPI | 1215381462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A198102) |
| Additional Taxonomies | 208800000X Urology (Licence: CO DR.0073569) |
| 208800000X Urology (Licence: WA 61588010) | |
| 208800000X Urology (Licence: NV 26069) | |
| 208800000X Urology (Licence: AZ 74572) | |
| 208800000X Urology (Licence: OR MD221619) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2026-07-30 |