| NPI | 1679899470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35131272) |
| Additional Taxonomies | 208800000X Urology (Licence: MD D0079729) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2018-03-14 |