| NPI | 1861950321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2024014394) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4351044105) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2024-08-07 |