| NPI | 1841306925 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208800000X Urology (Licence: OR MD11245) | 
| Additional Taxonomies | 208800000X Urology (Licence: WA MD00034645) | 
| Enumeration Date | 2006-08-22 | 
| Last Update Date | 2007-07-08 |