| NPI | 1245916493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL TRN42170) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC MMD.90233LL) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2025-05-25 |