| NPI | 1215425871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2023025695) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2023025695) |
| Enumeration Date | 2018-04-28 |
| Last Update Date | 2025-05-28 |