| NPI | 1982685541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35-03-7561J) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35037561J) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2011-06-15 |