| NPI | 1861620627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA OP60479551) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 5101018466) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-05-19 |