| NPI | 1306292024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KS 05-43714) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2026016769) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2026-06-30 |