| NPI | 1013196864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: WA MD 60207055) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A93105) |
| 2088P0231X (Licence: GA 062232) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2023-03-07 |