| NPI | 1669976932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.0070229) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 538599379) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-07-31 |