| NPI | 1003347618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA 19692) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: CA 20A19692) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-05-12 |