| NPI | 1770227654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R79431) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ R79431) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2023-06-12 |