| NPI | 1740491265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60340604) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301089615) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2013-07-09 |