| NPI | 1063413144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60116158) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101237570) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-05-25 |