| NPI | 1649405010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: PA MD457371) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT195471) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208800000X Urology (Licence: PA MD457371) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2016-07-03 |