| NPI | 1225277593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: GA 075449) |
| Additional Taxonomies | 208800000X Urology (Licence: TX P8936) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2018-10-12 |