| NPI | 1043539729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197755) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT197755) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2010-05-20 |