| NPI | 1750061784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX 47906) |
| Additional Taxonomies | 2088F0040X Urology, Female Pelvic Medicine and Reconstructive Surgery (Licence: TX 47906) |
| 2088P0231X Urology, Pediatric Urology (Licence: TX 47906) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-08-24 |