| NPI | 1558662403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.128997) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11014697A) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2017-08-16 |