| NPI | 1114485190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ R77258) |
| Additional Taxonomies | 208800000X Urology (Licence: OR MD218840) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2024-06-04 |