| NPI | 1245473990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: OR MD190807) |
| Additional Taxonomies | 208800000X Urology (Licence: SC 37937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2022-01-29 |