| NPI | 1508276734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: MD D0086434) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD478257) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 201403) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2023-09-18 |