| NPI | 1013443167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2024-00754) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 73311) |
| 208800000X Urology (Licence: WI 100582) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10059563) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-07-03 |