| NPI | 1316331705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: ID M-15321) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63646) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2020-10-08 |