| NPI | 1073147468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA A199841) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: MN 82624) | |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2026-08-12 |