| NPI | 1295028884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 83053) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MG456784) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2019-07-15 |