| NPI | 1457983389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SC 94192) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 12439666-1205) |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2025-07-14 |