| NPI | 1144581224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: NH 21692) |
| Additional Taxonomies | 208800000X Urology (Licence: NH 21692) |
| 208800000X Urology (Licence: MI 4301100440) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100440) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2021-07-21 |