| NPI | 1538629811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: AL MD.42104) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD484616) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-09-17 |