| NPI | 1124098173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA OP60272190) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2003018910) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-01-05 |