| NPI | 1073593638 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00028526) | 
| Additional Taxonomies | 174400000X Specialist (Licence: ID m8215) | 
| 208800000X Urology (Licence: MT 109260) | |
| Enumeration Date | 2006-01-19 | 
| Last Update Date | 2022-12-22 |