| NPI | 1710191408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IA 38523) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116015669) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2009-09-29 |