| NPI | 1922426071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MD D94174) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101266390) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2025-03-12 |