| NPI | 1992960660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD70031294) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD179794) |
| 208800000X Urology (Licence: MT 163360) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2026-06-12 |