| NPI | 1528396231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A115436) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60549429) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2022-07-21 |