| NPI | 1679034847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VT 042.0018015) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 331760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-08-28 |