| NPI | 1912266255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY TP736) |
| Additional Taxonomies | 208800000X Urology (Licence: TX S4781) |
| 208800000X Urology (Licence: KY R3789) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-06-10 |