| NPI | 1659415149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00042679,) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD069433L) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2021-05-12 |