| NPI | 1487150132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 58506) |
| Additional Taxonomies | 208800000X Urology (Licence: KY TP621) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0006986) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-02-01 |