| 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 |