| NPI | 1700971363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 9700526) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101049235) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-10-21 |