| NPI | 1831630037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AZ 67829) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD472257) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-05-30 |