| NPI | 1386039378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: NY 316666) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 30.138575) |
| 2088P0231X (Licence: OH 35.138575) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2022-10-07 |