| NPI | 1851891303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 70271) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101269491) |
| 208800000X Urology (Licence: NM MD2025-0278) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2025-07-01 |