| NPI | 1487869996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD28198) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60003290) |
| 208800000X Urology (Licence: OR LL16353) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-09-08 |