| NPI | 1649255423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WV 13890) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35045039) |
| 208800000X Urology (Licence: PA MD033304E) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2008-07-25 |