| NPI | 1831877612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME171571) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.147941) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-08-12 |