| NPI | 1912011677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD14340) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD00030399) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |