| NPI | 1871561126 |
|---|---|
| Former Name | WYATT JOE WOLLMANN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SD 7274) |
| Additional Taxonomies | 208800000X Urology (Licence: AL 025520) |
| Enumeration Date | 2006-03-12 |
| Last Update Date | 2012-04-04 |