| NPI | 1154680056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OK 32187) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 565314) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2025-02-17 |