| NPI | 1710930607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00039663) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101240091) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-11-27 |