| NPI | 1578769907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 267736) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: OR MD172494) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2015-06-17 |