| NPI | 1073035515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 326443) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.137219) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2023-11-29 |