| NPI | 1801419254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL OS22243) |
| Additional Taxonomies | 208800000X Urology (Licence: KY 61949) |
| 208800000X Urology (Licence: MI 5151014464) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014464) | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2026-07-07 |