| NPI | 1699201905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208800000X Urology (Licence: NE 34554) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2022-10-26 |