| NPI | 1356304273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 212819) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101289668) |
| 208800000X Urology (Licence: ND LT24613) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2026-06-26 |