| NPI | 1194221325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 339128) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: CA A195715) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2025-08-19 |