| NPI | 1407115876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2021043051) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: WI 67519) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2022-01-19 |