| NPI | 1922426816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 315880) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: CA A168319) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2024-07-26 |