| NPI | 1558824763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 14223440-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ R77351) |
| 208800000X Urology (Licence: CA A194524) | |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2025-07-01 |