| NPI | 1215376157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.0062183) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256144) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-07-15 |