| NPI | 1124341086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A109025) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A 109025) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A 109025) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2015-01-04 |