| NPI | 1760781645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35C.001715) |
| Additional Taxonomies | 208800000X Urology (Licence: LA 308825) |
| 208800000X Urology (Licence: TX T2324) | |
| 208800000X Urology (Licence: NY 286338-01) | |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2025-07-14 |