| NPI | 1114424306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.150603) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61408687) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-05-31 |