| NPI | 1760876056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: IL 125066517) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125066517) |
| 208800000X Urology (Licence: WA MD61620257) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2024-11-22 |