| NPI | 1265620363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA OP60085623) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 5101016185) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2023-03-07 |