| NPI | 1083637524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00048487) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2000155025) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-01-15 |