| NPI | 1912116989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA CA143438) |
| Additional Taxonomies | 208800000X Urology (Licence: CA 143438) |
| 208800000X Urology (Licence: KY 60284) | |
| 208800000X Urology (Licence: TN 46214) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-05-01 |