| NPI | 1861504185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35089090) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 144905-1) |
| 208800000X Urology (Licence: VA 0101249677) | |
| 208800000X Urology (Licence: KY 48668) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-09-28 |