| NPI | 1598325805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61521298) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD226642) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-07-09 |