| NPI | 1699772665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.133749) |
| Additional Taxonomies | 208800000X Urology (Licence: KY 34122) |
| 208800000X Urology (Licence: WV 25534) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2022-08-22 |