| NPI | 1063893717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101271565) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 264407) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-09-01 |