| NPI | 1558572842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101260400) |
| Additional Taxonomies | 208800000X Urology (Licence: IA 39800) |
| 208800000X Urology (Licence: OH 57011357) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-10-28 |