| NPI | 1366890717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61279664) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD210048) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2026-06-23 |