| NPI | 1235295619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY MD256222) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD437224) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY MD256222) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2021-03-01 |