NPI | 1053846584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208800000X Urology (Licence: CA A177912) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301111723) |
Enumeration Date | 2017-04-21 |
Last Update Date | 2023-07-25 |