| NPI | 1356336382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00029981) |
| Additional Taxonomies | 208800000X Urology (Licence: NM MD2013-0026) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2013-03-07 |