| NPI | 1851300131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60228883) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 52455) |
| 208800000X Urology (Licence: MN 48378) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-04-26 |