| NPI | 1740288158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD18423) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD000034615) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2012-05-03 |