| NPI | 1689811820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WV MS01003) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57012786) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2022-04-15 |