| NPI | 1861810913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60937720) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 64782-20) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-05-10 |