| NPI | 1003965310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00027498) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD00027498) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-04-07 |