| NPI | 1518919208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WI 49694) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 1562) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 49694) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-03-07 |