| NPI | 1639270812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00018397) |
| Additional Taxonomies | 208800000X Urology (Licence: AK MD2086) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-09-20 |