| NPI | 1972865335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60938684) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A155264) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2019-09-24 |