| NPI | 1902997836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD196953) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD 602 15304) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-09-01 |