| NPI | 1902226863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.131969) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.131969) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2018-12-24 |