| NPI | 1346531563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA 125559) |
| Additional Taxonomies | 208800000X Urology (Licence: CO 0059814) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2024-02-05 |