| NPI | 1659897908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX T4311) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 060-0004822) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2022-09-30 |