| NPI | 1003014267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 275768-1) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD444707) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2015-01-16 |