| NPI | 1609813260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35120277) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301077387) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-11-06 |