| NPI | 1760645840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MO 2013008093) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 264067) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 62628) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2021-12-09 |