| NPI | 1134562630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.134368) |
| Additional Taxonomies | 208800000X Urology (Licence: GA 1134562630) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2018-07-06 |