| NPI | 1730232364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 111023) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0053129) |
| 208800000X Urology (Licence: AZ 80545) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2026-06-16 |