| NPI | 1225441660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0102207451) |
| Additional Taxonomies | 208800000X Urology (Licence: FL OS15935) |
| 208800000X Urology (Licence: OH 34.014685) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA ot015671) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2023-08-02 |