| NPI | 1437130515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 14001511-1235) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 042458) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-02-13 |