| NPI | 1457541278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MD D0073462) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: MN 50973) | |
| 208800000X Urology (Licence: DE C1-0009994) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2012-07-09 |