| NPI | 1588393227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.151055) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 317961) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-07-03 |