| NPI | 1720257678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: WI 83829) |
| Additional Taxonomies | 208800000X Urology (Licence: IA 40164) |
| 2088P0231X (Licence: OH 091187) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2025-01-08 |