| NPI | 1003208026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.139772) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301502613) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2023-11-03 |