| NPI | 1467871178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 310602) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2020-01427) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-11-16 |