| NPI | 1619271780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MT201999) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 306091) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2023-07-03 |