| NPI | 1578803409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD473401) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208800000X Urology (Licence: TX S1774) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2021-09-21 |