| NPI | 1407851587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MD D0051424) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD70034077) |
| 174400000X Specialist (Licence: MD D0051424) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-10-15 |