| NPI | 1578096574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME155613) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME155613) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-04-10 |