| NPI | 1376637629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00012179) |
| Additional Taxonomies | 208800000X Urology (Licence: AK MD1223) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-09-20 |