| NPI | 1073748257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OH 35.126000) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT195306) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195306) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2024-04-18 |