| NPI | 1578942918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME141118) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106752) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2020-07-29 |