| NPI | 1225277445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301109317) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD452180) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2023-02-01 |