| NPI | 1780643015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 21528) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 21528) |
| 208800000X Urology (Licence: CO CDR.0001110) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2025-07-11 |