| NPI | 1851786065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CO DR.0066599) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2020-02440) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-08-11 |