| NPI | 1548565385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 297332) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.125495) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2021-09-29 |