| NPI | 1164868493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 57530) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX bp10047833) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-03-23 |