| NPI | 1710971262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD70014352) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD173791) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-09-26 |