| NPI | 1477915775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101272675) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME157602) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2026-01-06 |