| NPI | 1720135544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD436501) |
| Additional Taxonomies | 208800000X Urology (Licence: MD D077732) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-05-21 |