| NPI | 1235691940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.73504) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.007499) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-09-04 |