| NPI | 1396861241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.126702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087780) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-01-25 |