| NPI | 1780094896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA 14295) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 310673-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2023-03-11 |