| NPI | 1639330889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101246002) |
| Additional Taxonomies | 208800000X Urology (Licence: MD D0090586) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2021-01-27 |