| NPI | 1316082555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.053340) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 13842) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2017-06-14 |