| NPI | 1649891631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NC 2025-00725) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045859) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2025-08-20 |