| NPI | 1396943114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.125529) |
| Additional Taxonomies | 208800000X Urology (Licence: ID 5571656) |
| 208600000X Surgery (Licence: ME 233665) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2025-10-08 |