| NPI | 1639306954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA OP60935502) |
| Additional Taxonomies | 208800000X Urology (Licence: TX R1184) |
| 208800000X Urology (Licence: IN 02006672A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-07-17 |