| NPI | 1689679144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61509301) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 32469) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2024-04-12 |