| NPI | 1154683829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA OS017223) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT014530) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-01-03 |