| NPI | 1407937253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00024911) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD494768) |
| 208800000X Urology (Licence: AZ 78751) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2026-04-15 |