| NPI | 1720345671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 59217) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD60736958) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2022-03-21 |