| NPI | 1679014518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61477030) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76280) |
| 208800000X Urology (Licence: AZ 57269) | |
| Enumeration Date | 2017-03-11 |
| Last Update Date | 2023-11-22 |