| NPI | 1891096111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.134245) |
| Additional Taxonomies | 208800000X Urology (Licence: TX R0102) |
| 208800000X Urology (Licence: MI 4301097651) | |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2018-08-27 |