| NPI | 1174974828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MT 99190) |
| Additional Taxonomies | 208800000X Urology (Licence: WY 14005A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2023-01-19 |