| NPI | 1215556204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 79734) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046778) |
| 208800000X Urology (Licence: WI 85969-20) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-09-11 |