| NPI | 1770930703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 13396322-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61149364) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2023-11-27 |