| NPI | 1578797825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD458362) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA10755800) |
| 2088P0231X (Licence: PA MT208989) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2020-07-17 |