| NPI | 1619596095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL 31119) |
| Additional Taxonomies | 208800000X Urology (Licence: PA 489130) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2025-09-03 |