| NPI | 1356513014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60762111) |
| Additional Taxonomies | 208800000X Urology (Licence: OK 45916) |
| 208800000X Urology (Licence: NM MD2014-0118) | |
| 208800000X Urology (Licence: AZ 76400) | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2025-09-16 |