| NPI | 1063525723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: WA 60212116) |
| Additional Taxonomies | 208800000X Urology (Licence: HI 13103) |
| 2088P0231X (Licence: GA 062671) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2023-03-07 |