| NPI | 1811484520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD496003) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 29576) |
| 208800000X Urology (Licence: MN 65818) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2026-07-28 |