| NPI | 1457670432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: DE C1-0011829) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 165886) |
| 208800000X Urology (Licence: NC 2015-00555) | |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2017-01-23 |