| NPI | 1992050041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 9685201-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.124046) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2025-07-08 |