| NPI | 1689703639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00047512) |
| Additional Taxonomies | 208800000X Urology (Licence: KS 04-33094) |
| 208800000X Urology (Licence: MO 2008018539) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2008-07-02 |