| NPI | 1720437080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2024047976) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 05-48577) |
| 208800000X Urology (Licence: MI 5101026032) | |
| 208800000X Urology (Licence: MI 1720437080) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-01-23 |