| NPI | 1063944536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX T4906) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX T4906) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-11-30 |