| NPI | 1306167440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SC 40750) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60641813) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2025-04-25 |