| NPI | 1245355163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA 60011684) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A96790) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-11-27 |