| NPI | 1982068250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME171459) |
| Additional Taxonomies | 208800000X Urology (Licence: SC 86481) |
| 208800000X Urology (Licence: WI 68365) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-03-27 |