| NPI | 1639114127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00012468) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00012468) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2014-04-30 |