| NPI | 1104811801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD26747) |
| Additional Taxonomies | 208800000X Urology (Licence: WA md00046383) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-02-04 |