| NPI | 1518128768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL 124501) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 123851) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2021-11-02 |