| NPI | 1962840181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NC 191977) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 191977) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2021-03-08 |