| NPI | 1205060902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101255613) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 157459) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2014-05-27 |