| NPI | 1235470261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2022-00751) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: VA 0101256879) | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2024-07-22 |