| NPI | 1548359417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: KY 56132) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A97473) |
| 208800000X Urology (Licence: WA MD00044003) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-01-12 |