| NPI | 1679683742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A41710) |
| Additional Taxonomies | 208800000X Urology (Licence: OR OR MD 14298) |
| 208800000X Urology (Licence: WA MD 00033485) | |
| 208800000X Urology (Licence: HI MD 10824) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-05-31 |