| NPI | 1912240516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2019-01578) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD492629) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2025-11-24 |