| NPI | 1700233582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2023-02259) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35142401) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2023-09-05 |