| NPI | 1831639434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.154768) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301506575) |
| 208800000X Urology (Licence: MN 28959) | |
| 208800000X Urology (Licence: GA 96065) | |
| 208800000X Urology (Licence: MN 64094) | |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2025-11-10 |