| NPI | 1477788974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME120277) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT195582) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195582) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2016-10-12 |