| NPI | 1386008191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD472085) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63808) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-06-08 |