| NPI | 1437642352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA 165052) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD61480728) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2024-05-13 |