| NPI | 1821520586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD473619) |
| Additional Taxonomies | 208800000X Urology (Licence: OH APP-000228470) |
| 208800000X Urology (Licence: NC 222000) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2021-07-14 |