| NPI | 1700804168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME166208) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.057904) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2026-03-11 |