| NPI | 1821611203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CA 207726) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046168) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2026-06-02 |