| NPI | 1871084970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME156191) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77050) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2023-06-02 |