| NPI | 1578794459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD462245) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 53058) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2022-07-21 |