| NPI | 1215298104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.134964) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301100400) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2021-01-05 |