| NPI | 1942789938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208800000X Urology (Licence: OH 00798295) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2024-04-09 |