| NPI | 1407855356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 111028) |
| Additional Taxonomies | 208800000X Urology (Licence: TX H8394) |
| 208800000X Urology (Licence: IL 036177070) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2026-07-14 |