| NPI | 1265553374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60091579) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A83652) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2009-08-12 |