| NPI | 1558637199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD464492) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT201454) |
| 208800000X Urology (Licence: CT 56370) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 56370) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2020-08-13 |