| NPI | 1871882548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61499564) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD457730) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2024-05-08 |