| NPI | 1831182203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO 36203) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 89781) |
| 208800000X Urology (Licence: FL ME159390) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2025-07-08 |