| NPI | 1821244377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.095967) |
| Additional Taxonomies | 208800000X Urology (Licence: LA 205660) |
| 2088P0231X Urology Pediatric Urology (Licence: OH 35095967) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2019-02-21 |