| NPI | 1952971905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME161900) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.142003) |
| 282N00000X General Acute Care Hospital (Licence: OH 35.142003) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-08-01 |