| NPI | 1972923266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A141288) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61027268) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2023-01-05 |