| NPI | 1164675245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: DC 044326) |
| Additional Taxonomies | 208800000X Urology (Licence: CT 54046) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2021-09-02 |