| NPI | 1154525640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OK 30387) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 264258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2017-06-23 |