| NPI | 1043839764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NE 34212) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 34212) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-06-17 |