| NPI | 1629696794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 14213554-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ R78158) |
| 208800000X Urology (Licence: AZ 390200000X) | |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2025-12-04 |