| NPI | 1538215157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WI 57605-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2099) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-09-14 |