| NPI | 1790734721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301096814) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35086508) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2022-06-10 |