| NPI | 1184740045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ID M-11868) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087650) |
| 208800000X Urology (Licence: MI 4301087650) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2026-06-02 |