| NPI | 1750644860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: HI MD17615) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MD468490) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2022-03-22 |