| NPI | 1881791457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OR OR MD23337) |
| Additional Taxonomies | 208800000X Urology (Licence: WA WA MD00040480) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2026-07-13 |