| NPI | 1790005288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101257753) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2016-01606) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2026-03-13 |