| NPI | 1154648640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: UT 8535063-8905) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 46511) |
| 208800000X Urology (Licence: KY 46511) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2023-06-20 |