| NPI | 1679574081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 200201105) |
| Additional Taxonomies | 208800000X Urology (Licence: HI MD-21476) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-09-10 |