| NPI | 1669904488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0102207053) |
| Additional Taxonomies | 208800000X Urology (Licence: MT 132544) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2025-07-15 |