| NPI | 1356452684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301100716) |
| Additional Taxonomies | 208800000X Urology (Licence: WA ML20007631) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-07-13 |