| NPI | 1992325724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AL L.6701SP) |
| Additional Taxonomies | 208800000X Urology (Licence: WV 31956) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2026-01-28 |