| NPI | 1053578831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60453256) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA09916800) |
| 2088F0040X Urology, Urogynecology and Reconstructive Pelvic Surgery (Licence: NJ 25MA09916800) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2019-06-17 |