| NPI | 1588838890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX Q6119) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME121023) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207T00000X Neurological Surgery (Licence: TX Q6119) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2021-10-15 |