| NPI | 1982741252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: CO 44743) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR-44743) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-05-25 |