| NPI | 1952716730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 85177) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.135828) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-04-30 |