| NPI | 1942654041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101275192) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT210389) |
| 208800000X Urology (Licence: MD D94457) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2025-02-28 |