| NPI | 1679505515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60771954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60771954) |
| 208800000X Urology (Licence: OH 35099644) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-12-04 |