| NPI | 1811359425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WI 77181) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: NY 340539) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2026-01-21 |