| NPI | 1548641202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX T9634) |
| Additional Taxonomies | 208800000X Urology (Licence: CA A147267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2022-09-06 |