| NPI | 1679872238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A147715) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD 60491830) |
| 208800000X Urology (Licence: WI 3031-320) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2023-06-26 |