| NPI | 1326332024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2017-00629) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 173345) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2017-11-30 |