| NPI | 1275066441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA OP61546556) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 70820) |
| 208800000X Urology (Licence: GA 60) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2026-01-14 |