| NPI | 1265603633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 071836) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 232755) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2014-05-07 |