| NPI | 1649200023 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208800000X Urology (Licence: FL me80500) | 
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301512961) | 
| Enumeration Date | 2006-07-03 | 
| Last Update Date | 2025-08-14 |