| NPI | 1255898870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301510641) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 1022075) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2025-08-18 |