| NPI | 1659351583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ND 22262) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 205838) |
| 208800000X Urology (Licence: WI 81438) | |
| 208800000X Urology (Licence: MN 73594) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2026-10-02 |