| NPI | 1295301158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.156854) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4351047637) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2026-08-13 |