| NPI | 1558719609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61153831) |
| Additional Taxonomies | 208800000X Urology (Licence: WA 61153831) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2024-05-13 |