| NPI | 1356513014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60762111) |
| Additional Taxonomies | 208800000X Urology (Licence: NM MD2014-0118) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2020-08-13 |