| NPI | 1558593046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 10486903-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60474017) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2018-10-17 |