| NPI | 1801245956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX T1000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10058193) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-01-28 |