| NPI | 1588650758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 42996) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35080658) |
| 208800000X Urology (Licence: KY TP710) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2014-07-02 |