| NPI | 1104801356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60675016) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD20565) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2019-12-16 |