| NPI | 1174933048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.142520) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 57.026312) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2022-02-07 |