| NPI | 1295267557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 315410) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63846) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-12-01 |