| NPI | 1528599610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208800000X Urology (Licence: NY 312894) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-05-19 |