| NPI | 1609230903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A151433) |
| Additional Taxonomies | 208800000X Urology (Licence: MD D94645) |
| 208800000X Urology (Licence: PA MD480920) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2026-05-12 |