| NPI | 1790248953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IA DO-06668) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 11941) |
| 208800000X Urology (Licence: SD 15520) | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2026-06-22 |