| NPI | 1932551389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA FE60610281) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD461448) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2021-05-19 |