| NPI | 1356609549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: IA 44920) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 000000000) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2023-05-08 |