| NPI | 1699947333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD161674) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 57.009724) |
| 208800000X Urology (Licence: WA MD60336494) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2026-03-06 |