| NPI | 1801162292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.139170) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 298598) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2021-01-10 |