| NPI | 1619161007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 12704181-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: NE 24825) |
| 208800000X Urology (Licence: GA 068279) | |
| 208800000X Urology (Licence: GA 68279) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2025-06-24 |