| NPI | 1710988746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00020768) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA md0020768) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2025-06-16 |