| NPI | 1679745327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX U0251) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 275901) |
| 208800000X Urology (Licence: OH 35.128690) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2023-03-03 |