| NPI | 1790199636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: SC 87458) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT206264) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2022-12-20 |