| NPI | 1255561775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301094972) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35125792) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2015-06-19 |