| NPI | 1225033996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA G152876) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35072311) |
| 208800000X Urology (Licence: CO DR.0069372) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2026-01-30 |