| NPI | 1245497825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60217654) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11012590A) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-06-23 |