| NPI | 1629141577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35059949) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61373509) |
| 208800000X Urology (Licence: IA 000000) | |
| 208800000X Urology (Licence: ID MC-1749) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-05-18 |