| NPI | 1629360714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MA 276922) |
| Additional Taxonomies | 208800000X Urology (Licence: NC 2016-00676) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2018-11-15 |