| NPI | 1972969012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208800000X Urology (Licence: GA 103700) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2025-03-28 |