| NPI | 1932369832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: TX P6344) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12267) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2013-09-23 |