| NPI | 1164632998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD154494) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD.MD.60217779) |
| 208800000X Urology (Licence: OR LL16074) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2026-08-19 |