| NPI | 1225272503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301110910) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: NY 2738371) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2016-09-02 |