| NPI | 1942612536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.0070061) |
| Additional Taxonomies | 208800000X Urology (Licence: KY 54765) |
| 208D00000X General Practice (Licence: VA 0101260413) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2023-07-25 |