| NPI | 1942297460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA 025209MD00023482) |
| Additional Taxonomies | 208800000X Urology (Licence: WY TL6528) |
| 208800000X Urology (Licence: WY 13556A) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2021-04-13 |