| NPI | 1578663399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00034193) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00034193) |
| 208800000X Urology (Licence: ID M-7195) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-07-14 |