| NPI | 1578910261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX T4749) |
| Additional Taxonomies | 208800000X Urology (Licence: KY TP250) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-08-16 |