| NPI | 1083823009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD60617953) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016304) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-08-09 |