| NPI | 1275067142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A203125) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2023019454) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-08-05 |