| NPI | 1588822845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.084180) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 238303-1) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2009-01-02 |