| NPI | 1780940023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: SC 82909) |
| Additional Taxonomies | 208800000X Urology (Licence: IL 036.142863) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-05-12 |