| NPI | 1982067526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KS 0444871) |
| Additional Taxonomies | 208800000X Urology (Licence: MO 2021029775) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2021-08-10 |