| NPI | 1326278458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61288164) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: OH 35.094194) | |
| 208800000X Urology (Licence: NY 271419) | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2023-05-12 |