| NPI | 1740633569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MN 60282) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 60282) |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2017-10-30 |