| NPI | 1003663972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 10087335) |
| Additional Taxonomies | 208800000X Urology (Licence: TX 10087335) |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |