| NPI | 1366734717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 34.012699) |
| Additional Taxonomies | 208800000X Urology (Licence: LA 303775) |
| 208800000X Urology (Licence: NJ 25MB09553900) | |
| 208800000X Urology (Licence: OH 12699) | |
| 208800000X Urology (Licence: WV 3182) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2020-04-03 |