| NPI | 1568826030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2021-01597) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2021-01597) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-10-04 |