| NPI | 1194785642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.097897) |
| Additional Taxonomies | 208800000X Urology (Licence: CT 47702) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2019-08-14 |