| NPI | 1710995295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: ID 7161277) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD25800) |
| 208800000X Urology (Licence: WA MD00048852) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-10-11 |