| NPI | 1215923479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60108844) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME86059) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2011-06-10 |