| NPI | 1659487692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR OR MD18947) |
| Additional Taxonomies | 208800000X Urology (Licence: WA WA MD00037620) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-02-04 |