| NPI | 1023377736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.138581) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0101264911) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-08-02 |