| NPI | 1619979952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 22220) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD224797) |
| 208800000X Urology (Licence: TX W0430) | |
| 208800000X Urology (Licence: WA MD61665978) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2026-08-12 |