| NPI | 1902464324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD470983) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MD470983) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 100349-01) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2021-05-21 |