| NPI | 1649650631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: TX T6295) |
| Additional Taxonomies | 208800000X Urology (Licence: TX T6295) |
| 2088P0231X Urology Pediatric Urology (Licence: DC DO034980) | |
| 2088P0231X Urology Pediatric Urology (Licence: TX PENDING) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT016593) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2022-08-30 |