| NPI | 1659721199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 12658136-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 266333) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2025-07-31 |