| NPI | 1740301712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TN 46147) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 46147) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-02-15 |