| NPI | 1225521370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 76854) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 76854) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2024-08-23 |