| NPI | 1831680297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.147765) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301114978) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2023-05-31 |