| NPI | 1356605729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61296925) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A128244) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2022-07-22 |