| NPI | 1851788848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 55529) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35.138861) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.138861) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2021-08-03 |