| NPI | 1558976407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4351053799) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 21591) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2025-07-20 |