| NPI | 1417528357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 1417528357) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK M083810221) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2026-04-22 |