| NPI | 1861634289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MT MED-PHYS-LIC-58876) |
| Additional Taxonomies | 208800000X Urology (Licence: WA 208800000X) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2025-04-10 |