| NPI | 1962760595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301503155) |
| Additional Taxonomies | 208800000X Urology (Licence: CA 147785) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208800000X Urology (Licence: GA 86206) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2024-12-19 |