| NPI | 1669694295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: UT 13794147-1205) |
| Additional Taxonomies | 208800000X Urology (Licence: TX P0271) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-06-18 |