| NPI | 1851607857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX Q4771) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN15229) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2018-03-17 |