| NPI | 1932328259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2010-00548) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 57010681) |
| 208D00000X General Practice (Licence: VA 0101288048) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2026-04-28 |