| NPI | 1548796675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2022-01840) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112271) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2022-10-12 |