| NPI | 1801419254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 5151014464) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151014464) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2021-01-26 |