| NPI | 1104365188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA C196294) |
| Additional Taxonomies | 208800000X Urology (Licence: CA C196294) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2024-08-05 |