| NPI | 1851412431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR OR MD08135) |
| Additional Taxonomies | 208800000X Urology (Licence: WA WA MD00035280) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |